The impact of abdominal computed tomography in a tertiary referral centre emergency department on the management of patients with inflammatory bowel disease

Abstract

Although exposure to diagnostic radiation may be associated with increased risk of malignancy, the use of abdominal CT (ACT) in the last decade has increased for patients in the emergency department (ED). To examine the impact of ACT ordered in the ED on management of patients with inflammatory bowel diseases (IBD), as well as to quantify the cumulative effective dose (CED) of radiation received by these patients. A total of 152 patients with Crohn's disease (CD) and 130 patients with ulcerative colitis (UC) that presented to the ED in a tertiary centre between 2009 and 2011 were identified. For patients that had an ACT, chart review assessed if the ACT findings changed clinical management. CED of diagnostic radiation (DR) was calculated for all imaging studies between 1 January 2006 and 30 August 2012. Abdominal CT use was 49% for CD and 19% for UC. ACTs with findings of penetrating/obstructive disease were 35% for CD. Urgent non-IBD-related diagnoses were found in 13% for CD and 28% for UC (P<0.05). ACT caused a change in management in 81% of CD and 69% of UC patients. Mean CED from DR was 77.4±63.0mSv (median 53mSv) for CD and 67.2±51.0mSv (median 56mSv) for UC (P=0.47). The CED for the 80-month period exceeded 75mSv in 35% and 36% respectively (P=0.99). Although abdominal CT often changes management of IBD patients in the emergency department, this population carries a very high-risk of radiation exposure. Efforts should be made to decrease this risk by development of low-radiation protocols, and wider use of MRI/ultrasound.